It started, of course, with a nightmare, which led to a long train of memories, none of them pleasurable or comforting. It ended with this: tomorrow afternoon I have an appointment with my therapist and her supervisor. Dick Gottlieb and I, in the context of our workshop on “Treating the Psychiatrically Maltreated,” have explored the issue: if the therapist and the patient are not working well together then the therapist can request a meeting with her supervisor—so why shouldn’t the patient also be able to request a meeting with the supervisor?

And so, tomorrow afternoon, I am meeting with the therapist, who is a psychologist, and one of the managing partners of her agency, who is also a psychologist but a generation older (and more experienced). The agency is operating and/or maintaining an office that does not meet the standards set by the Americans with Disabilities Act (ADA). I am a disabled American. Ultimately, the issue became this: the therapist failed to effectively advocate to get the agency to make sure the property met ADA standards.

When asked why she failed to press the issue with her superiors, she said, “I had to think of my job.” What she meant was: I put myself first, and I was afraid.

Dick Gottlieb, a clinical social work supervisor, told me that when he was still in training, he had an experience which led him to the understanding that the patient must always come first. In his words, “If I wasn’t in the business to put the patient first then I shouldn’t be in the business at all.”

Consequent to what the therapist saw happening, she wanted to file a complaint against CPEP. Her supervisor told her not to, so she didn’t.

So where does that leave us? It leaves us with government funded patient care that does not meet government standards. And it leaves us with institutional managers who won’t file complaints to get substandard services upgraded. And it leaves us (“us” being the plural of “me”) with a therapist who is both a coward and selfish. She put herself ahead of her patients. She is paid to put her patients first for forty hours a week. It’s not a lifestyle; it’s a job—and her job is to work for the betterment of her patients.

So what do we do now? Can the therapist be rehabilitated? Can she become a person of courage? Can she learn to put her patients first? If she can learn, who will teach her? I tried and failed. I spoke to her direct supervisor, who did nothing. Will the managing partner take on the challenge? The fact is that this therapist is Every Therapist. Virtually all of them kowtow to their superiors and do as they are told. Whatever happened to people who stand up for what is right? Whatever happened to people who know what is right?

For me, “right” is explicitly spelled out in the sacred writings of the major religions, e.g., the Bhagavad Gita, Holy Bible and Holy Koran. My willingness and ability to stand up for what is right is based on two things. First, the sacred writings that teach me what is right and, second, the Divinity who will support and protect me in the doing of right. However, I have a friend who likewise “does right” without any apparent reference to sacred texts or the Lord.

If I am doing right then I am doing God’s work and I know he’s got my back. That helps a lot but apparently isn’t essential for the doing of right. How is it that a person can know what is right but not do it? To me, the functional definition of “sin” is knowing what is right but not doing it. How can people fail to do right? How can so many people walk upright without any apparent backbone? How can people fail to do what is right when what is right is spelled out in civil law?

I don’t understand any of this but what I am sure of is that I don’t feel safe with this therapist—or most of the others. The reasons the “Treating the Psychiatrically Maltreated” workshop came into being were because so many therapist—be they social workers, psychologists or psychiatrists—aren’t doing what is right. They aren’t creating safe treatment environments for their patients and their patients are getting hurt.

It’s not just about meeting ADA requirements. It’s about having the courage and moral rectitude to stand up for vulnerable patients whenever and wherever they are put in danger by the psychiatric system, which happens everywhere on a daily basis. The psychiatric system has become a corrupt purveyor of injury, and what are we to do about that?

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About annecwoodlen

I am a tenth generation American, descended from a family that has been working a farm that was deeded to us by William Penn. The country has changed around us but we have held true. I stand in my grandmother’s kitchen, look down the valley to her brother’s farm and see my great-great-great-great-great-grandmother Hannah standing on the porch. She is holding the baby, surrounded by four other children, and saying goodbye to her husband and oldest son who are going off to fight in the Revolutionary War. The war is twenty miles away and her husband will die fighting. We are not the Daughters of the American Revolution; we were its mothers.
My father, Milton C. Woodlen, got his doctorate from Temple University in the 1940’s when—in his words—“a doctorate still meant something.” He became an education professor at West Chester State Teachers College, where my mother, Elizabeth Hope Copeland, had graduated. My mother raised four girls and one boy, of which I am the middle child. My parents are deceased and my siblings are estranged.
My fiancé, Robert H. Dobrow, was a fighter pilot in the Marine Corps. In 1974, his plane crashed, his parachute did not open, and we buried him in a cemetery on Long Island. I could say a great deal about him, or nothing; there is no middle ground. I have loved other men; Bob was my soul mate.
The single greatest determinate of who I am and what my life has been is that I inherited my father’s gene for bipolar disorder, type II. Associated with all bipolar disorders is executive dysfunction, a learning disability that interferes with the ability to sort and organize. Despite an I.Q. of 139, I failed twelve subjects and got expelled from high school and prep school. I attended Syracuse University and Onondaga Community College and got an associate’s degree after twenty-five years. I am nothing if not tenacious.
Gifted with intelligence, constrained by disability, and compromised by depression, my employment was limited to entry level jobs. Being female in the 1960’s meant that I did office work—billing at the university library, calling out telegrams at Western Union, and filing papers at a law firm. During one decade, I worked at about a hundred different places as a temporary secretary. I worked for hospitals, banks, manufacturers and others, including the county government. I quit the District Attorney’s Office to manage a gas station; it was more honest work.
After Bob’s death, I started taking antidepressants. Following doctor’s orders, I took them every day for twenty-six years. During that time, I attempted%2

You have put your own needs ahead of the patient’s. You are young and new to the profession, and what matters most to you is your status. “In the end, I think the problem is a lack of respect for the training of the social worker, me.”
No. In the beginning, the problem is that the patient’s mother died and nobody is inviting her to talk about it. You make no mention of any inpatient or on-going psychotherapy, or grief counseling. A person in her thirties lost her mother “several months ago” and yet there is no indication you even brought up the subject with the patient.
In fact, you appear not to have talked to the patient at all. Are you not a clinical social worker? The only direct contact you report having with the patient was to tell her that you’d gotten her freedom revoked and her imprisonment continued. How powerful did that make you feel?
The patient comes first. The patient wanted to leave the hospital. You recite an endless list of her behaviors that you don’t like. Tough. It’s not about what you like or how you would live your life. The fact that the patient stuck cigarettes up her butt is wholly irrelevant. You are measuring the adequacy of her lifestyle by your own standards and you have no right to do that. To what degree do you fear losing control of your own life?
For a lot of reasons, mostly venal, the hospital staff wanted to put the patient out and you fought to keep her imprisoned. For what? To get her reestablished on her medications? Drugs are not the solution. Or because you wanted her to be discharged to some lifestyle that resembled yours? She has the right to live any damned way she chooses, including not bathing and having sex with strangers. It’s not yours to decide.
You failed to offer the patient counseling. You did not invite her to talk about her mother’s death. You did not ask her what she wanted. You rejected her lifestyle choices. You fought the entire medical hierarchy to keep her imprisoned when she wanted to leave. You made it all about you and not at all about her. Her spirit was in pain and all you cared about was how her body lived.
“Doing what’s Right” means fighting the system for what the patient wants, not what you want.